Numerous compounds have been synthesized to combat the human immunodeficiency virus (HIV) since it was discovered to be the etiological cause of the acquired immunodeficiency syndrome (AIDS) in 1983. A focal point of AIDS research efforts has been and continues to be the development of inhibitors of human immunodeficiency virus (HIV-1) reverse transcriptase, the enzyme responsible for the reverse transcription of the retroviral RNA to proviral DNA (W. C. Greene, New England Journal of Medicine (1991), 324:308-17; Mitsuya et al., Science (1990), 249:1533-44; E. J. DeClercq, Retrovirus (1992), 8:119-34). Inhibitors include non-nucleoside reverse transcriptase inhibitors or NNRTIs that bind to a specific allosteric site of the HIV reverse transcriptase near the polymerase site and interfere with reverse transcription by either altering the conformation or the mobility of the reverse transcriptase, thus leading to noncompetitive inhibition of the enzyme (Kohlstaedt et al., Science (1992), 256:1783-90).
Several classes of compounds have been identified as NNRTIs of HIV. Examples of these include:                1) 1-[(2-hydroxyethoxy)methyl]-6-phenylthio)thymines (HEPT) (Tanaka et al., J. Med. Chem. (1991), 34:349-57; Pontikis et al., J. Med. Chem. (1997), 40:1845-54; Danel et al., J. Med. Chem. (1996), 39:2427-31; Baba et al., Antiviral Res. (1992), 17:245-64);        2) bis(heteroaryl)piperazines (BHAP) (Romero et al., J. Med. Chem. (1993), 36:1505-8);        3) dihydroalkoxybenzyloxopyrimidine (DABO) (Danel et al., Acta Chemica Scandinavica (1997), 51:426-30; Mai et al., J. Med. Chem. (1997), 40:1447-54);        4) 2′,5′-bis-O-(tertbutyldimethylsilyl)-3′-spiro-5″-(4″-amino-1″, 2″-oxathiole-2″, 2″-dioxide)pyrimidines (TSAO) (Balzarini et al., PNAS USA (1992), 89:4392-96);        5) phenylethylthiazolylthiourea (PETT) derivatives (Bell et al., J. Med. Chem. (1995), 38:4929-36; Cantrell et al., J. Med. Chem. (1996), 39:4261-74);        6) tetrahydro-imidazo[4,5,1-jk][1,4]-benzodiazepine-2(1H)-one and -thione (TIBO) derivatives (Pauwels et al., Nature (1990), 343:470-4);        7) phosphorus-substituted imidazole derivatives (PCT Publication No. WO 03/091264 A2 to Gilead Sciences, Inc.);        8) alpha-anilinophenylacetamide (alpha-APA) derivatives (Pauwels et al., PNAS USA (1993), 90:1711-15); and        9) indole derivatives (U.S. Pat. No. 5,527,819 to Merck & Co. and counterpart PCT Publication No. WO 94/19321).        
Indole derivatives described in U.S. Pat. No. 5,527,819 assigned to Merck & Co. have been shown to be inhibitors of HIV reverse transcriptase. Some of these compounds exhibited IC50 values against HIV reverse transcriptase at concentrations of from 3-35 ηM. A process for synthesizing optionally substituted indoles by a palladium-catalyzed annulation between a ketone and an iodoaniline was also developed at Merck & Co. (Chen et al., J. Org. Chem. (1997), 62(9):2676-77).
The compounds disclosed in the '819 patent are generally represented by the following broad structural Formula (III):
in which the variables X, Y, Z, R and R6 are broadly defined.
U.S. Pat. No. 5,124,327 to Merck & Co. discloses a class of optionally substituted sulfonylphenyl indole compounds. The patent reports that the compounds are active as reverse transcriptase inhibitors and could be useful in the treatment of HIV infection and AIDS.
U.S. Pat. No. 6,710,068 to Idenix Pharmaceuticals, Ltd., discloses a class of phenylindoles substituted with at least two moieties other than hydrogen on either or both rings. See also PCT Publication No. WO 02/083126.
PCT Publication No. WO 2004/014364 to Idenix Pharmaceuticals discloses another class of phenylindoles that displays enhanced anti-HIV activity. These compounds are also substituted with at least two moieties other than hydrogen on either or both rings. In addition, these compounds incorporate a number of different substituents with a carboxamide functionality at position-2 on the indole, the position shown in formula (II) above as “Z”. Typical placement of substituents is at the 3″ and 5″ positions on the phenyl ring, and at the 4′ and 5′, 5′ and 6′, or 5′ and 7′ positions on the benzo ring of the indole moiety.
Bristol Myers Squibb disclose various optionally substituted indoles, azaindoles, piperazines, and pyrrolidines for the treatment of HIV and/or AIDS in several U.S. patents and U.S. and PCT publications. See U.S. Publication Nos. 2004/0006090; 2004/0063746; 2003/0096825; 2003/0236277; and WO 03/068221.
WO 01/02388 to SmithKline Beecham S.P.A discloses optionally substituted phenylindoles with a carbamyl substituent that are alleged to have utility in the treatment of HIV, AIDS, osteoporosis, cancers, and Alzheimer's disease.
Warner-Lambert Company discloses various indole-thiazepinones, oxazepinones, diazepinones, benzothiophenes, benzofurans, and indole-2-carboxamides for the treatment of HIV in U.S. Pat. Nos. 5,424,329; 5,565,446; 5,703,069; and WO 96/29077.
Shinogi & Co. report optionally substituted indole derivatives that are viral integrase inhibitors useful as anti-HIV drugs in U.S. Publication No. 2002/0019434 and U.S. Pat. Nos. 6,716,605 and 6,506,787.
U.S. Pat. No. 5,945,440 to Kleinschroth et al. discloses a class of indolocarbazole amides for the treatment of a variety of diseases including cancer, viral diseases (including HIV), cardiac and vascular diseases, bronchopulmonary diseases, inflammatory disorders, degenerative diseases of the central nervous system, and other diseases.
U.S. Pat. No. 4,866,084 to Gunasekera et al. teaches certain bisindole alkaloid compounds that have antiviral and antitumor activity, including HSV (herpes simplex virus). U.S. Pat. No. 5,935,982 to Dykstra et al. reports a different class of bisindoles that have utility versus retroviral infections and especially HIV.
U.S. Pat. No. 5,852,011 to Matsunaga et al. discloses a class of indole derivatives substituted by a heteroaryl function and an amide function. The compounds are said to possess antitumor, antiviral, and antimicrobial properties.
U.S. Pat. No. 5,935,982 to Dykstra et al. discloses a class of bis-indoles and specifically propose their use for treating retroviral infections, and especially infection by HIV.
U.S. Pat. No. 5,929,114 to Domagala et al. discloses a class of arylthio and bithiobisarylamide compounds, including indole derivative, that reportedly have antibacterial and antiviral activity.
U.S. Pat. No. 5,830,894 to Pevear et al. discloses a class of triazinoindole derivatives that reportedly have anti-pestivirus activity, most notably BVDV activity.
Indoles have been used in the treatment of diseases other than HIV. U.S. Pat. No. 5,981,525 to Farina et al. discloses a complex array of indoles for use in the treatment of osteoporosis based on their ability to inhibit osteoclast H+-ATPase and thus reduce bone resorption. U.S. Pat. No. 6,025,390, also to Farina et al., teaches another group of indole derivatives, termed heteroaromatic pentadienoic acid derivatives, also for the treatment of osteoporosis. U.S. Pat. No. 5,489,685 to Houpis et al. discloses a series of compounds that are furo(2,3-b) pyridine carboxylic acid esters, allegedly useful in the treatment of HIV.
It is known that over a period of time, antiviral agents that are active against HIV induce mutations in the virus that reduce the efficacy of the drug. This was apparently the problem exhibited by the Merck indoles in U.S. Pat. No. 5,527,819 (Williams et al., J. Med. Chem., 1993, 36(9), 1291-94). Drug resistance most typically occurs by mutation of a gene that encodes an enzyme used in viral replication, and most typically in the case of HIV, reverse transcriptase, protease, or DNA integrase. It has been demonstrated that the efficacy of a drug against HIV infection can be prolonged, augmented, or restored by administering the compound in combination or alternation with a second, and perhaps third, antiviral compound that induces a different mutation from that caused by the principal drug. Alternatively, the pharmacokinetics, biodistribution, or other parameters of a drug can be altered by such combination or alternation therapy. In general, combination therapy is typical rather than alternation therapy since combination therapy induces multiple simultaneous pressures on the virus. However, one cannot predict which mutations will be induced in the HIV-1 genome by a given drug, whether the mutations are permanent or transient, or how an infected cell with a mutated HIV-1 sequence will respond to therapy with other agents in combination or alternation. These factors are exacerbated by the fact that there is a paucity of data on the kinetics of drug resistance in long-term cell cultures treated with modern antiretroviral agents.
Therefore, there is a need to provide new compounds and methods for the treatment of HIV.
It is thus an object of the present invention to provide new compounds, compositions, methods and uses for the treatment of patients infected with HIV.
It is yet another object of the present invention to provide new compositions and methods for the treatment of patients infected with HIV that exhibit activity against drug-resistant forms of the virus.